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y <br /> TOWN OF MASHPEE <br /> Statement of Discontinuance,Change of Residence,Change of Location of Business, <br /> Withdrawal,or Deceased from Business or Partnership,Change of Business Name or Owner Name <br /> DATE <br /> Discontinuance <br /> In conformity with the provisions of Chapter one hundred and ten, section five, of the General <br /> Laws, as amended, the undersigned hereby declare(s) that I/We has (have) this day discontinued (retired <br /> from) (withdrawn from) the business of Ca4P A Lk 44 r r5 Ckv—r '4 Mate, <br /> conducted at t�t�o�tl c (&)�`^ (7ci��� <br /> STREET i <br /> SIGNATURE <br /> Ch nge of Location of Business <br /> I hereby state that the location of the business/my residence as it appears on the Business Certificate filed <br /> • on IV I a E r 4ltas been changed to <br /> Name of Business <br /> SIGNATURE <br /> Change of Name of Business or Owner <br /> I hereby state that the name of the business or the owner as it appears on the Business Certificate has <br /> been changed from <br /> to <br /> SIGNATURE <br /> Notary <br /> Barnstable ss. <br /> Date <br /> Personally appeared before me the above named and made oath <br /> • that the foregoing statements are true. <br /> Name-Notary Public <br /> Commission Expires <br /> Origform/Discontin uance <br />